key: cord-1006370-0m5m204f
authors: Jacob, Smrithy; Dworkin, Aviva; Romanos‐Sirakis, Eleny
title: A pediatric patient with sickle cell disease presenting with severe anemia and splenic sequestration in the setting of COVID‐19
date: 2020-08-09
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28511
sha: eafe8bbe99078e60c7178314a0a5a3476fc906da
doc_id: 1006370
cord_uid: 0m5m204f

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The majority of patients with splenic sequestration present with additional clinical symptoms, most commonly fever, and many with a concomitant infection. 1 The effects of COVID-19 on patients with sickle cell disease are not yet well described. We present a case of a pediatric patient with sickle cell disease who presented with severe anemia in the setting of splenic sequestration and COVID-19. We are not aware of any other published cases of COVID-19 presenting in this manner.

The patient is a 2-year 9-month-old male diagnosed with homozygous hemoglobin SS disease. He presented to his hematologist's outpatient clinic with irritability and an isolated fever of 102 • F approximately 9 h prior to arrival. He received one dose of ibuprofen at home at the time of fever, with no return of fever prior to presentation to the clinic. Patient's review of symptoms was otherwise negative with no upper respiratory symptoms, no decrease in oral intake, no diarrhea, and no known sick contacts. The patient's medical history is significant for five prior hospitalizations during which he was transfused, but had no history of acute chest syndrome or splenic sequestration, with normal splenic ultrasounds documented on prior admissions.

His medications included hydroxyurea, penicillin-VK, and folic acid.

In the clinic, the patient was afebrile, tachycardic to 152 beats per minute, with a blood pressure of 104/61 mmHg and no tachypnea or desaturations noted at room air. His physical exam was significant for irritability and a palpable spleen edge approximately 1.5 cm below the costal margin. The patient had no jaundice or scleral icterus. Initial COVID-19, the patient had one isolated fever that did not recur and had no apparent usual symptoms of a viral syndrome. While the patient presented with a severe presentation of splenic sequestration with an undetectable hemoglobin, he had a mild clinical course during hospitalization, with no additional apparent morbidity related to COVID-19. We must keep COVID-19 in the differential diagnosis even without

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